Junghyun Kim, MD Veterans Health Service Medical Center Seoul, Republic of Korea*
Rita Khoury, MD Geriatric Psychiatry Fellow Department of Psychiatry and Behavioral Neuroscience Saint Louis University School of Medicine Saint Louis, Missouri
George T. Grossberg, MD Samuel W. Fordyce Professor Director, Geriatric Psychiatry Department of Psychiatry and Behavioral Neuroscience Saint Louis University School of Medicine Saint Louis, Missouri Section Editor, Geriatric Psychiatry Current Psychiatry
*At the time this article was written
Disclosures Drs. Kim and Khoury report no financial relationships with any company whose products are mentioned in the article, or with manufacturers of competing products. Dr. Grossberg is a consultant to Allergan.
Borderline personality disorder. In a case series of 6 women, BTA injections in the glabellar region were reported to be particularly effective for the treatment of borderline personality disorder symptoms that were resistant to psychotherapy and pharmacotherapy.31 Two to 6 weeks after a 29-unit injection, borderline personality disorder symptoms as measured by the Zanarini Rating Scale for Borderline Personality Disorder and/or the Borderline Symptom List were shown to significantly improve by 49% to 94% from baseline (P ≤ .05). These findings emphasize the promising therapeutic role of BTA on depressive symptoms concomitant with the emotional lability, impulsivity, and negative emotions that usually characterize this personality disorder.31,32 A small sample size and lack of a placebo comparator are limitations of this research.
Neuroleptic-induced sialorrhea. Botulinum toxin injections in the salivary glands have been investigated for treating clozapine-induced sialorrhea because they are thought to directly inhibit the release of acetylcholine from salivary glands. One small RCT that used botulinum toxin B (BTB)33 and 1 case report that used BTA34 reported successful reduction in hypersalivation, with doses ranging from 150 to 500 units injected in each of the parotid and/or submandibular glands bilaterally. Although the treatment was well tolerated and lasted up to 16 weeks, larger studies are needed to replicate these findings.33-35
Orofacial tardive dyskinesia. Several case reports of orofacial tardive dyskinesia, including lingual dyskinesia and lingual protrusion dystonia, have found improvements in hyperkinetic movements following muscular BTA injections, such as in the genioglossus muscle in the case of tongue involvement.36-39 These cases were, however, described in the literature before the recent FDA approval of the vesicular monoamine transporter 2 inhibitors valbenazine and deutetrabenazine for the treatment of tardive dyskinesia.40,41
Studies examining botulinum toxin’s application in areas of psychiatry other than depression are summarized in Table 2.31,33,36-38
Continue to: Promising initial findings but multiple limitations
